Unit VI- Cardiovascular Alterations.

Angina pectoris
 Angina pectoris

The term “angina pectoris” comes from the Latin “angor

pectoris” and means “strangulation in the chest.”

Angina pectoris consists of partial

blockage of the coronary arteries . It
can occur when the heart is forced to
exert greater effort and the body is
unable to increase blood flow to said
organ.
 Angina pectoris

Angina is a symptom of coronary artery disease, the most

common heart disease.

This occurs when a substance called plaque builds up in the

Approximately when a
arteries that carry blood to the heart, reducing
lumen, ischemiablood
plaque occludes 70% of the
arterial flow.
When stenosis exceeds
80-90%, ischemia may
occurs due to stress and occur at rest.
not with rest.

Causes
It is usually preceded by physical or emotional
excitement ; occasionally for a large meal; driving a car
during busy traffic hours can also precipitate a crisis; and
it also occurs while exercising in a cold environment, in
 which case there are patients who experience almost
immediate relief when moving from a cold room to a hot
one.

Causes

When the arteries of the heart are affected and cannot adjust
to the increased demand for blood, the heart's nerves
transmit painful urgent warning messages to the brain.
This pain, which usually does not exceed 5 minutes, is due
to the brain, out of confusion, feeling impulses from
nearby locations such as the arms , neck or jaw.
Angina pectoris is very common.

In men it generally occurs after 30 years of age, and in

women later. The cause, in most cases, is
arteriosclerosis.
 Types of Angina pectoris
Exertional angina: is pain caused by
physical activity, or any situation
that involves exertion that involves
a greater demand for oxygen by
the myocardium. It is a pain that is
usually brief and disappears when
the effort that caused it is stopped,
or with the administration of
nitroglycerin (vasodilator).
 Types of Angina pectoris
Angina at rest: is one that occurs spontaneously, that is,
without any relation to effort. As for
its duration, it is very variable,
sometimes being prolonged
episodes of pain that resemble a
heart attack. We must highlight a
subtype that is variant, vasospastic
or Prinzmetal angina, which occurs
at rest, suddenly and, above all,
during night rest.

Mixed angina: this type includes all

those forms where characteristics
of effort angina and rest angina
coexist at the same time.
Types of Angina pectoris
 Types of Angina pectoris.

Another much more practical way of classifying them is:

Stable angina: would correspond to
effort angina in which its
characteristics and the functional
capacity of the patient (which
reflects the ability of individuals to
develop activities that are part of
their independent and productive
life) have not changed during the
last month. It is due to a
temporary reduction in the oxygen
supply and with good evolution.
Unstable angina: that of
unpredictable evolution and
 Types of Angina pectoris
variable prognosis; That is, we cannot know how it will
evolve: whether it will lead to a cure, or whether it will
progress towards a heart attack. Grouped under this term
are rest angina and accelerated or progressive angina,
which is exertional angina that has worsened in terms of
the number of episodes, intensity of pain, or level of effort
with which it appears. It is due to a non-total obstruction in
a coronary artery; It does not usually entail complications,
but it does have a worse evolution than the previous one.
Variant, vasospastic or Prinzmetal angina: it is a variety of unstable
angina that manifests suddenly, and frequently during night rest.
Unlike unstable angina and heart attack, the mechanism causing this
problem is not the occlusion of a vessel, but is due to a spontaneous
closure of the coronary vessel (vasospasm). The cause of this
vasospasm is not completely clarified, although it is more common in
 Types of Angina pectoris
smokers and in people with high cholesterol and blood pressure. It can
occur in healthy coronary arteries or in coronaries with atherosclerosis
lesions. It can be triggered by cold, emotional stress, consumption of
certain medications or drugs such as cocaine. This condition is
common in young people.
 Classification
stable angina
It is exertional angina whose pattern has not changed in the
last month of evolution. According to its functional degree,
it is classified into:
• Grade I. The pain appears only with extreme efforts.
• Grade II. Slight limitation of daily life.
• Grade III. Important limitation of daily life.
• Grade IV. Any activity causes angina.
New-onset exertional angina, grades I and II, is considered
stable.
Classification
Unstable angina
It is characterized by its unpredictable evolution and includes
various types, such as rest angina; stable angina of recent onset,
grades III and IV; progressive angina (whose attacks increase in
duration, intensity, frequency or functional degree), and angina
during the first month after infarction. Angina at rest includes
Prinzmetal variant angina (due to coronary vasospasm with
reversible elevation of the segment) and prolonged angina.
Unstable angina carries a mortality rate lower than that of acute
myocardial infarction, but higher than that of stable angina,
mainly in the first days after diagnosis, which is why it has a
different therapeutic approach.
 Symptoms

Chest pain and a sensation of sharp, suffocating oppression,

Chest pain usually lasts between minutes and 10-15 1-2

minutes (sometimes a sensation is felt).
usually behind the sternum, and sometimes extending to one
arm or the other.
minutes and 10-15 minutes (sometimes there is a sensation of
of heaviness pressure in the chest that does not amount to
uo pain).
Feeling of anxiety or imminent death.
Profuse sweating.
Pallor.
Angina is a symptom, not a disease. A direct
result of a lack of blood in the heart muscle, which
is known as ischemia.
Prevention
The patient must modify the risk factors and triggering situations.
The treatment of angina pectoris is aimed at reducing the load
on the heart and its oxygen needs:
• Give up smoking.
• Lose the extra kilos.
• Perform exercise.
Having angina does not mean that the patient has to become
sedentary. In fact, exercise is a key part in the management of
coronary heart disease, but it must be compatible with the
limitations imposed by pain and your general condition.
 Complications
• Arrhythmias.
• A heart attack.
• Heart failure.
 Diagnosis

There are no laboratory tests for the diagnosis of angina

pectoris. However, some tests are done to detect or rule
out damage to the heart, as well as to check for other
problems, such as hyperthyroidism or anemia, which can
force the heart to beat faster, use more oxygen, and cause
angina.
Diagnosis

The diagnosis of angina is

clinical, it does not need
confirmation if the symptoms
and general medical history
suggest it.
The electrocardiogram, outside of the pain episode, is normal
in 50 percent of patients. With pain, it almost always
presents characteristic alterations.

Nursing Diagnoses.
• Alterations in health maintenance related to a lack of
knowledge about pathology care.
• Anxiety related to anginal crisis.
• Pain related to myocardial ischemia.
• Activity intolerance related to acute pain, arrhythmias.
• Reduction in cardiac output related to myocardial
ischemia, drug effects, arrhythmias.
 Treatment
Among the most effective and recommended medications are:
• Nitroglycerin: dilates the coronary arteries and the pain usually
reverses within minutes. It is taken by placing a pill under the tongue
or also as a spray. It may cause headache as a side effect.
• Calcium antagonists or calcium channel blockers: they prevent
the entry of calcium into the heart cells. This decreases the tendency
of the coronary arteries to narrow and the stress on the heart, so your
oxygen needs also decrease.
• Beta blockers: They work by blocking many effects of adrenaline in
the body, particularly the stimulating effect on the heart. The result is
that the heart beats more slowly and less forcefully, and therefore
 Treatment
requires less oxygen. They also lower blood pressure.
• Surgery: In case of unstable angina or stable angina that resists
treatment with medications, the obstruction of the coronary vessels
can be corrected, either by pass (bypass) or, in some cases, by
coronary angioplasty.
Nursing interventions.
• Frequently measure orthostatic vital signs to evaluate the hemodynamic
effects of medications.
• Inform the doctor if the diastolic pressure decreases below 60.
• Monitor ECG for conduction disturbances in patients receiving verapamil.
• If changes in anginal pain appear, it becomes more intense, lasts longer,
suspect acute myocardial infarction, correct other problems to reduce the
demand for oxygen in the myocardium, such as hypertension.
• Explain to the patient the importance of anxiety reduction to help control
angina and apply medications to control it.
• Reduce activity below the point at which anginal pain occurs.
 Bibliography
• http://www.fbbva.es/TLFU/microsites/salud_cardio/mult/f
bbva_libroCorazon_cap27.pdf
• http://www.grupocto.es/web/medicina/ar/pdf/manual_7_c
ap_BN.pdf
• http://www.dmedicina.com/enfermedades/enfermedades-
vasculares-y-del-corazon/angina-pecho.html
• http://www.texasheart.org/HIC/Topics_Esp/Cond/angin_s
p.cfm
• http://www.texasheart.org/HIC/Topics_Esp/Cond/angin_s
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